ENG2023-0173_Utility_Application_3.28.2023_6.02.26_PM_3449576DocuSign Envelope ID: EDA8A7B7-3B3A-4AF9-A2A5-7F013636A5E0
RECEIVED
Mar 30 2023
WATER AVAILABILITY APPLICATION
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name HBRE INVESTMENTS
Phone Number
206.380.9989
Email
AUGIEBUKO@GMAIL.COM
Address
1951 3RD AVENUE W
City
SEATTLE
State WA
Zip 98119
Property Inf• •
Project Name 310 DALEY TOWNHOUSES
Associated Permit Number BLD2022-1329, BLD2022-1325, BLD2022-1326, BLD2022-1327
Address 310 DALEY STREET
City EDMONDS
State WA
Zip 98020
Parcel No. 004342-026-001-01
Does the property currently have water service? IN Yes (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
N Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable: BLD2022-1328, PLN2021-0074
SECTION B
X Applicant certifies that this project is a single-family residence, multi -family project of four units or
less with combo water/fire lines, or short plat subdivision (four single-family lots or less), in which case
completion of a full utility availability study shall not be required. Please sign below and submit this form
through www.MyBuildingPermit.com.
❑ For all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
3/28/2023
APPLICANT SIGNATURE: A-01's61'&wsLi DATE:,es ess
Augustus Bukowski
APPLICANT PRINTED NAME:
Form Updated 12/9/2021